Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 69997 | CA |
NPI | 1003140252 |
---|---|
Provider Name | Miss Elizabeth Cruz |
First Address | Santa Monica, CA 90404 |
Second Address | Santa Monica, CA 90404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2009 |
Last Update Date | 02/02/2016 |